Centers of Excellence in Interventional Cardiology and Radiology

INTERVENTIONAL CARDIOLOGY

Coronary angioplasty

Best coronary angioplasty center

Our center has saved the lives of over 4,500 patients in the last 4 years

The most modern equipped angiography room , an exceptional medical team

The first centre in our country that performs fully bioresorbable implants

Only 24 hours hospitalization

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031 9300

Generalities

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A coronary angioplasty is a procedure used to widen blocked or narrowed coronary arteries.

Coronary angioplasty is necessary when hardening and narrowing of the coronary arteries prevents the heart from getting enough blood to function normally.

Coronary angioplasty is also known as percutaneous transluminal coronary angioplasty (PTCA) or percutaneous coronary intervention (PCI).

A coronary angioplasty is one of the most common types of treatment for the heart. Over 800 procedures are performed in our centers each year.

19Coronary angioplasty has many advantages compared with surgical treatment of coronary heart disease (coronary artery bypass), carrying lower risks and being less expensive. A much shorter recovery time allows patients to resume their normal activites and return at their workplace within just a few days.

Indications

Coronary angioplasty is performed when critical stenoses (>70%) are found at coronary angiography.

Procedure

During an angioplasty, a flexible tube called a catheter is used to insert a stent into the coronary artery. The procedure usually takes 30 minutes, but it can take longer depending on how many segments of the artery need treatment.

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Before a coronary angioplasty is carried out, the arteries of your heart need to be assessed to make sure that the procedure is technically possible. This is done using coronary angiography (see more on our website in the Coronary Angiography section).

In our centers, coronary angioplasties are performed at the same time with coronary angiographies, the cost of the coronary angiography being included in that of the coronary angioplasty.

Thus, instead of doubling the risks performing two procedures, we offer our patients the alternative of treating them in a single intervention, with minimal risks.

A coronary angioplasty takes place in a room called a catheterisation laboratory, which is fitted with x-ray video to allow the doctor to monitor the procedure on a screen.

You will be asked to lie on your back on an x-ray table. You will be linked up to a heart monitor and given a local anaesthetic to numb your skin. An intravenous (iv) line will also be inserted into a vein, in case you need to have painkillers or a sedative.

The interventional cardiologist choses the type of vascular approach, either the femoral or radial artery, and local anesthesia is made before puncturing the artery.

During the intervention the patient is conscious and can speak with the doctor performing the procedure, being continuously connected to heart monitoring machines.

After the local anesthesia, a sheath is introduced in the artery (a plastic tube allowing the handling of all the necessary equipment, wire guides, and catheters). Thus, the doctor will guide the catheter through the artery, passing it through the main artery in the body (the aorta) and into the opening of the left or right coronary arteries.

3A thin, flexible wire is then passed down the inside of the blood vessel being treated to beyond the narrowed area. A small balloon is passed over the wire to the narrowed area and inflated for up to 60 seconds. This compresses the fatty material on the inside walls of the artery to widen it, and may be done several times.

While the balloon is inflated, the artery will be completely blocked and you may have some chest pain. However, this is normal and is nothing to worry about. The pain should go away when the balloon is deflated. Ask the cardiologist for pain medication if you find it uncomfortable. You should not feel anything else as the catheter moves through the artery, but you may feel an occasional missed or extra heartbeat. This is nothing to worry about and is completely normal.

Most of the times, balloon dilation of the stenosed artery is not enough, therefore a stent must be implanted in order to keep the artery open. A stent is a short, wire-mesh tube that acts like a scaffold to keep the coronary artery open.

What type of stent?

There are many types of stents, of different dimensions, made of different materials. There are two main types of stents: bare metal stents (BMS) – uncoated, and drug-eluting stents (DES) – coated with medication that reduces the risk of the artery becoming blocked again.

The most important inconvenient when using bare metal stents is that, in 20% of cases, the arteries begin to narrow again after a period of time. This is because the immune system sees the stent as a foreign body, causing swelling and excessive tissue growth around the stent. This problem can be avoided by using drug-eluting stents. These are coated with medication that reduces the body’s abnormal response and tissue growth.

Drug-eluting stents (DES) are coated with an antiproliferative drug, which allows drug elution into the coronary wall for weeks or months after stent implantation, thus avoiding artery restenosis (there is only a 4-5% risk of restenosis if DES are implanted, compared to a 20% risk of restenosis in case of bare metal stents).

In our centers a new, revolutionary coronary stent its available, the new Bioresorbable Vascular Scaffold – Abbott Absorb™

Absorb is a Bioresorbable Vascular Scaffold (BVS) system that elutes everolimus in a similar way to Drug Eluting Stents and then resorbs naturally into the body leaving no permanent scaffold*. Absorb is comprised of four key design elements: a bioresorbable scaffold, a bioresorbable coating, everolimus and the DES delivery system.

Absorb defines a new paradigm – Vascular Reparative Therapy (VRT). VRT is designed to restore the vessel to a more natural state§, making natural vascular function possible. While stenting performance is characterized by a single phase of revascularisation, Absorb was designed with the premise of working in three phases to deliver VRT:

  • Revascularisation
  • Restoration
  • Resorption
  • Revascularisation

In the Revascularisation phase, Absorb revascularises like a best in class DES, XIENCE. Absorb achieves this goal by offering good deliverability, excellent conformability, a minimum of acute recoil, high radial strength, and controlled release of the anti-proliferative drug everolimus to minimise neointimal growth.

  • Restoration & ResorptionThe goal of the restoration phase is to enable natural vessel function for improved long-term outcomes. Restoration of the vessel occurs as the scaffold benignly resorbs without inflammation. Absorb gradually ceases providing luminal support and evolves from an intact scaffold to a discontinuous structure embedded within neointimal tissue. As the scaffold degrades, the polymer is converted into lactic acid which is metabolised through the Krebs cycle and is ultimately converted into benign by-products of carbon dioxide and water.79

Before the procedure, our doctors clearly explain to all patients the benefits and risks of each type of stent.

When the procedure is over, the balloon, wire and catheter are removed and bleeding is prevented by applying firm pressure or by using a special vascular closure device called Angio-Seal.

This device provides a way of closing arterial punctures and minimizing the discomfort associated with cardiac catheterization procedures; it involves the introduction of collagen in the femoral artery immediately after the procedure in order to obtain haemostasis in only 2 hours.

Rapid closure and sealing of the puncture site results in quick and efficient hemostasis, shortening recovery time and rapidly restoring the patient’s mobility. Thus, patients can move their leg freely and walk several hours after the procedure.

Is is painful?

No. The whole procedure is carried out under local anesthesia, the patient being conscious during the whole duration of the procedure.

How long does it take?

The procedure takes about 30 min – 2 hours and is performed in the cardiac catheterization laboratory.

Risks

As with all interventional procedures, coronary angioplasty carries a risk of complications. Several factors increase your risk of experiencing these complications.

Who is at risk?

Factors that increase your chance of having complications include:

  • Your age – the older you are, the higher the risk. For example, a 60-year-old man with no other risk factors has a less than 1% risk of developing complications, while an 80-year-old has a 3% risk.
  • Whether you have renal (kidney) disease – the intravenous dye used during an angioplasty can occasionally cause further damage to your kidneys.
  • Whether more than one coronary artery has become blocked – this is known as multi-vessel disease.
  • Whether you have a history of serious heart disease – this could include heart failure.

Our doctors will give you more information about your individual circumstances and level of risk.

Complications

Other potential complications that can occur – very rarely – after an angioplasty include:

  • allergic reactions to the administered compunds.
  • a heart attack (myocardial infarction) – 1 in 10000 procedures
  • a stroke
  • excessive bleeding after the procedure, or occurence of a hematoma at the puncture site.

Before you leave hospital, you will be told about the medication you need to take. You will also be given advice on improving your diet and lifestyle.

Also, you will be given a date for a follow-up appointment to check on your progress.

Before procedure

78Before the intervention, the interventional cardiologist must be prevented of any prior history of allergic reactions to drugs or other compounds, or if there is a suspicion of pregnancy. Current medication must be clearly specified, and any other medical conditions must be mentioned.

Blood tests are taken (hemoglobin level, coagulation tests, renal function tests, or other specific tests).

The patient should not eat/drink before the procedure

After procedure

Since the procedure is minimally invasive, the recovery is usually very fast and the majority of patients can leave the hospital the next day, and resume their normally activities within a few days.

Twenty-four hours after the procedure the vascular puncture site will be inspected to exclude any potential local complications, and certain blood tests will be taken (hemogram, renal blood tests – creatinine, blood urea nitrogen, and other specific tests).

Drink at least 2 liters of water per day in the following days in order to eliminate the contrast agent from the bloodstream.

You may have a bruise under the skin where the catheter was inserted. This is not serious, but it may be sore for a few days. Very rarely, the wound can become infected. Keep an eye on it to check that it is healing properly.

After having a coronary angioplasty, avoid any heavy lifting for about a week or until the wound has healed. Do not drive for a week after the procedure.

Indications about recovery and postprocedural treatment will be clearly specified to all patients before being discharged.

Further treatment

Most people need to take blood-thinning medication for up to one year after having an angioplasty. This is usually a combination of low-dose aspirin and a medication called clopidogrel. It is very important to follow your medication schedule. Stopping this medication early greatly increases the risk of the stent becoming blocked suddenly and causing a myocardial infarction.

The course of clopidogrel will be withdrawn after the agreed period, but most patients need to continue taking low-dose aspirin for the rest of their life. Another angioplasty may be needed if the artery becomes blocked again and your angina symptoms return.

Important!

Find out the cost for this procedure!

Or
you can contact us!

Call Center
031 9300

In our centers, coronary angioplasties are performed at the same time with coronary angiographies, the cost of the coronary angiography being included in that of the coronary angioplasty.

Thus, instead of doubling the risks performing two procedures, we offer our patients the alternative of treating them in a single intervention, with minimal risks

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